24 May How the Hospital Price Transparency Rule Helps You
Are you concerned about the cost of treatment at a hospital? Thanks to the Hospital Price Transparency Rule, you may have access to cost information on their website!
What is the Hospital Price Transparency Rule?
The Hospital Price Transparency Rule, created by the U.S. Department of Health and Human Services (HHS), requires certain hospitals to provide clear, accessible online information about the prices of items and services they provide. This includes things like x-rays, outpatient visits, and lab testing. The rule went into effect on January 1, 2021.
Prior to the transparency rule, hospitals were only required to tell the public about their “chargemasters,” the list of standard costs for each service they provide. Often, the price for a service varied drastically, depending on the negotiated cost with third-party payers, including health insurance companies.
The Hospital Price Transparency Rule now allows patients to find prices for various services, allowing them to compare costs and make informed decisions about their health care.
What Hospitals Must Provide Pricing Information Under the Transparency Rule?
Providers in any state or territory of the United States that are licensed as a hospital must provide price information. There are some exceptions, including hospitals operated by the U.S. Department of Veterans Affairs and the Indian Health Service.
How Can You Find the Prices?
Hospitals must provide their prices on a public website without having to register for an account, submit any personally identifiable information, or pay anything. The price information must include a plain-language description of each service.
However, if a hospital provides patients with an internet-based price estimator tool, it may meet the transparency rule requirement.
Hospitals must update the information each year.
Do Hospitals Charge the Same Prices for Everyone?
No. And, the Hospital Price Transparency Rule requires that the hospital include prices for five different situations:
- The gross charge, or the hospital’s standard charge, without any discount or negotiated price
- The discounted price if a patient paid cash
- The price if you have specific health insurance plans
- The lowest price negotiated with all third-party payers (e.g., a health insurance company).
- The highest charge negotiated with all third-party payers (e.g., a health insurance company).
Why is the Hospital Price Transparency Rule Helpful?
The transparency rule allows patients to find out what the potential cost for care will be and to compare the cost of care at different hospitals.
And, if an individual does not have health insurance, or the hospital is not in-network for a specific health insurance plan, it provides people with information that may help them to negotiate a lower cost for services.
How are Hospitals Implementing the Rule?
Although hospitals may face a penalty of $300 per day if they do not provide their prices, a large number of hospitals have not made this information public. In early February of 2021, about 65 out of 100 surveyed large hospitals in the United States had not complied with the transparency rule, according to Health Affairs.
What if My Hospital Does Not Provide Prices?
If a hospital does not provide prices on their website, an individual can contact the hospital and indicate that it is their understanding that the hospital must post its pricing and ask for that information.
An individual can also submit a complaint to the Centers for Medicare and Medicaid Services at HHS. Individuals should provide as much relevant evidence as possible. Any record of communications with the hospital and any digital evidence (e.g., a screenshot of the hospital website) are helpful.
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